Increased distance of lung from chest wall Changes in the intensity of breath sounds Importantly, decreases in breath sounds can also result from various other mechanisms ( Table 5–1), including failure of air to enter the lungs (airway obstruction) and processes that increase the distance between the lung and chest wall (effusion). Since sound travels less efficiently through air, it makes sense that decreases in the intensity of breath sounds will be detected in diseases characterized by hyper-inflation of the lung (eg, asthma, emphysema, or chronic bronchitis). Whispering pectoriloquy is also characteristic of a large cavity and may be heard above the level of a pleural effusion. A useful phrase such as “one, two, three” spoken as a whisper by the patient is heard more loudly by the examiner. Whispering pectoriloquy involves having the patient whisper a word or phrase that contains several high-pitched components. Egophony, which means “goat sound,” refers to the high-pitched bleating sound “ay” heard over consolidated regions of lung as the patient repeats the sound “ee.” Compared to normal lung, in consolidated regions, a higher pitched sound will be better heard and allows for recognition of a spoken phrase such as “ninety-nine.” This is termed bronchophony. This means that there is more transmission of sound through a pneumonic than through a normal lung, allowing one to identify areas of consolidation by using physical examination techniques such as egophony (nasal or bleating sound), bronchophony, and whispering pectoriloquy. In general, sound travels better through liquid than it does through air thus, pathologic states resulting in increased airway fluid (ie, consolidation by blood, water, or pus) facilitate the transmission of breath sounds ( Table 5–1). Significant differences in the intensity of breath sounds provide valuable insights into the pathologic state of the lung. Bilateral and unilateral decreases in breath sounds can be of great clinical significance, but some asymmetry of sound intensity is common in normal lungs secondary to minor differences in regional airflow. Inspiratory-expiratory ratio during auscultation.Ĭare must be taken when assessing the significance of variations in the intensity of lung sounds. Other less frequent sounds heard on auscultation are squeaks and a pleural rub.įigure 5–1. The three most common types of adventitious breath sounds are wheezes, rhonchi, and crackles. Qualitative differences in breath sounds are collectively called adventitious breath sounds. The inspiratory:expiratory ratio (1:3) heard over the central airways better approximates the actual time spent in each phase of the respiratory cycle ( Figure 5–1).Ībnormal breath sounds include sounds of differing intensity, duration, or quality when compared to those of the normal respiratory cycle. Listening to alveolar breath sounds (also called vesicular sounds), the expiratory phase sounds shorter (a 3:1 inspiratory:expiratory ratio) because expiration is a passive process resulting in lower flow rates and less turbulence. In the periphery of the lung, higher pitched components are more attenuated than lower pitched ones, resulting in the muffled quality of normal alveolar breath sounds. These sounds, appropriately named tracheal or bronchial breath sounds, consist of high- and low-frequency sounds. During respiration, this can occur when airflow reaches a critical velocity such as during forced expiration or when airflow is physically disrupted as occurs at airway branch points.ĭuring auscultation, breath sounds are heard best over the trachea and central airways. Turbulent airflow occurs when the orderly arrangement of particles in laminar flow becomes disrupted. Recognize the implications of abnormal sounds in individuals with specific lung disease.įormulate a differential diagnoses for the causes of various abnormal lung sounds.īreath sounds result, in large part, from turbulent airflow. Understand the pathogenesis and pathophysiology of normal and abnormal breath sounds.
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